You are a Registered Psychotherapist in the outpatient mental health program of a hospital in Hamilton. Ibrahim, 54, was referred by his family physician sixteen weeks ago for depressed mood and irritability following a back injury that ended his work as a machinist. He has attended eight sessions, arrived early each time, and has spoken at length about his older brother, who manages the family's affairs and, in Ibrahim's account, dismisses him. Your work has been mainly cognitive behavioural, with some attention to grief about the loss of his trade. In session eight, as he described a phone call with his brother, you said, 'I notice that each time there's a chance to say what you want, you choose to protect his version of things.' He paused, said 'maybe', and was quiet for the rest of the hour. He did not attend session nine and did not call. Today he arrives twenty minutes late for session ten, keeps his coat on, and sits without taking off his gloves. When you ask how the past two weeks have been, he says, 'Fine.' After a silence he says, 'Last time you told me this is my own doing. I get enough of that at home.'